2024 Brings Enlargement to Medicaid in New York State

On Tuesday, January 9, 2024, the Facilities for Medicare & Medicaid Providers (“CMS”) accredited a request from New York State (“NYS”) to amend its Medicaid part 1115(a) demonstration (the “Demonstration Modification”),[1] which is able to permit for vital growth of the NYS Medicaid program, together with:

  • elevated funding in infrastructure and expanded protection for health-related social wants (“HRSN”) companies,
  • incentive packages for security internet hospitals and suppliers in geographies with longstanding data of well being disparities, and
  • built-in major care or behavioral well being companies specializing in high-risk enrollees (e.g., youngsters, pregnant and postpartum people, chronically homeless, and people with substance use problems).

The Demonstration Modification is out there right here within the type supplied by CMS and the NYS Division of Well being (“DOH”). This publish highlights sure key initiatives that will affect the healthcare panorama in NYS within the close to future.

  1. HRSN Initiatives:
    • Within the curiosity of accelerating the accessibility and high quality of care to handle HRSN, the Demonstration Modification seeks to enhance integration between major care suppliers and community-based organizations. CMS accredited $500 million in infrastructure spending for NYS to determine social care networks (“SCNs”) to offer HRSN screening and referral companies to Medicaid beneficiaries which can be focused populations for HRSN companies. One other $3.173 billion shall be made out there to cowl certified companies supplied to handle HRSN, which incorporates the potential for people with high-risk pregnancies to obtain protection for diet interventions throughout their being pregnant and for 2 months postpartum.
    • As described within the Demonstration Modification, “HRSN companies shall be supplied by way of a mix of the fee-for-service and managed care supply methods, with case administration and referral companies administered by way of SCNs in every area of the state.” CMS signifies within the Demonstration Modification that, efficient in April 2024, HRSN advantages shall be put into motion by way of non-risk preparations in managed care, with the intent to combine such advantages in full threat managed care packages by March 2027.
  2. HERO Initiatives:
    • The Demonstration Modification additionally gives for the institution of a well being fairness regional group (“HERO”), which CMS describes as a “contracted statewide entity designed to develop regionally-focused approaches to cut back well being disparities, advance high quality and well being fairness for general populations, and help the supply of HRSN companies.” The HERO will work together with SCNs and participate in knowledge analytics, wants assessments, and engagement classes masking focused populations. A finances of $125 million has been approved for HERO use in developments towards well being fairness and value-based preparations all through the state.
  3. Medicaid Hospital World Funds Initiative
    • CMS approved as much as $2.2 billion to be allotted to a Medicaid Hospital World Funds Initiative (the “Hospital Initiative”) supporting a subset of security internet hospitals in search of to transition from fee-for-service reimbursement fashions to value-based packages specializing in well being fairness. Monetary help from the Hospital Initiative is restricted to pick hospitals based mostly on standards established by the Demonstration Modification. Moreover, in an effort to obtain any incentive funds below the Hospital Initiative, a taking part hospital should submit an utility to take part within the States Advancing All-Payer Well being Fairness Approaches and Growth (AHEAD) mannequin, which is able to set world budgets for taking part hospitals based mostly on the relevant hospital’s historic income and geographic charges.[2]
  4. Workforce Initiatives
    • As a response to lingering workforce points which can be impacting NYS (amongst different geographies), CMS approved as much as $694 million to help workforce recruitment and retention over a three-year interval. The funding targets elevated availability of healthcare suppliers that serve Medicaid beneficiaries and different at-risk or traditionally under-supported populations in NYS.
    • The workforce help features a pupil mortgage compensation program, which shall be out there to sure professionals in specialties experiencing workforce shortages (e.g., psychiatrists, with an emphasis on little one/adolescent psychiatrists, major care physicians, dentistry, nurse practitioners, and pediatric scientific nurse specialists) in various quantities decided by specialty for many who make “a four-year full-time work dedication to a apply panel that features no less than 30 p.c Medicaid and/or uninsured members.”

In a press launch issued by CMS, HHS Secretary Xavier Becerra known as the Demonstration Modification “a necessary step for advancing well being fairness in our nation,” and Secretary Becerra “encourage[s] all states to affix New York in benefiting from this chance.”[3] The CMS press launch emphasizes a cross-sector method to addressing HRSN and different well being fairness points, together with a call-back to HHS’s November 2023 Name to Motion to handle HRSN throughout the nation.[4] The press launch reiterates the HHS stance that “nobody sector can do that work alone.”

If in case you have any questions or want to focus on the Demonstration Modification or the affect it might have in your group or the healthcare trade, please don’t hesitate to succeed in out to a member of Sheppard Mullin’s Healthcare staff.


[1] As described on Medicaid.gov, “Part 1115 of the Social Safety Act offers the Secretary of Well being and Human Providers authority to approve experimental, pilot, or demonstration initiatives which can be discovered by the Secretary to be more likely to help in selling the targets of the Medicaid program.”

[2] States Advancing All-Payer Well being Fairness Approaches and Growth (AHEAD) Mannequin (CMS)

[3] CMS Approves New York’s Groundbreaking Part 1115 Demonstration Modification to Enhance Main Care, Behavioral Well being, and Well being Fairness | CMS

[4] HHS Name to Motion: Addressing Well being-Associated Social Wants in Communities Throughout the Nation | ASPE

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